For all of you who are starting medical school this month I wish you well in your future endeavors with your medical career. As part of orientation week, the dean of your university is going to give a heart-warming speech about helping others and heeding the call of duty. At the end of the day you’re going to feel like a real member of the team and that your purpose at this school will be to become a scholar, a healer, and a gentleman.

I got the same speech when I started medical school three years ago. And indeed, I did feel mighty confident in my university’s ability to teach me to become a fantastic doctor. What I wish had happened is for the dean to have told us the truth. Had he done so, that speech would’ve gone something like this:

Welcome everybody to Half University! I’m happy that you’re all here with us to embark an endeavor to become a physician. Although four years sounds short, this will be one of the most time-consuming and hardest experiences you’ll ever go through. When you interviewed here we told you that each and everyone of you are a valued member of our team. That was all a lie. You are really nothing more than a burden to the residents and the attendings at this institute. Oh sure, you will run into some fantastic teachers during your first two years here. But the vast majority of staff members will see you as nothing more than a nuisance. You will get in the way of their ability to see patients quickly. As punishment you’ll have to endure hours of torture through a humiliating process that we call pimping. Be prepared to be asked any and all questions regarding your patients—including their astrological sign, what their dietary habits are like, and what’s the half-life of the medication we’re using to treat their disease.

We’ve really got you by the balls now. There’s no other way to become a physician in the United States than to go through one of the AAMC member schools. While I don’t doubt that anyone of you is smart enough to learn all the basic sciences on your own in one year, we’re going to make you spend two years to learn the same material because instead of giving you time off to study, we’re going to make you come in for Physicianship Training so that you can learn about everything from Medicare reimbursements, to how Hispanics think, to our political views on health insurance and the non-insured—all in your first year of medical school, where none of this information will be applicable for many years to come. All the while, were going to charge you an excess of $60,000 to learn something that you could teach yourself for free.

Look to your left; look to your right. In years past one of those two individuals would have flunked out of school because of the academic demands placed upon them by this university and others. However, we currently have a doctor shortage in this country. Therefore, we are forced to find ways to advance everyone of you through each year until you finally graduate. Now look to your left; look to your right. One of those individuals will sink into a horrible depression over the next four years in the realization that he or she should not be here. However, due to economic and familial pressures, that individual will stay on and possibly kill a few patients before getting their M.D.

You are a burden. Let me reiterate to you that neither the residents nor the faculty truly have any desire to teach you. The residents will dislike you so much that they will have you go down to the radiology suite to fetch x-rays just so you they can be without your presence for several more minutes. The residents will threaten you and say things like, “I evaluate students based off of their enthusiasm. If you aren’t willing to go that extra mile and get my x-rays, I must question your commitment for this field.”

All of you have your own individual reasons for coming to medical school. Many of you use your personal statements and your interviews as a chance to try to fool us on the admissions committee that you have nothing but pure intentions of serving others. For some of you, this statement is true. Unfortunately, our system will find a way to wear you down. For others, this statement was utterly false—and the only reason you’re here is to either make money or to win the affection of your parents who never paid attention to you while you were growing up. Whatever your reasons are, they don’t matter anymore. Your desire to work in South America or Africa as a medical missionary is not going to help you when you’re trying to memorize anatomical tables of muscles. Realize that this is going to be hard no matter who you are.

All of you were at the top of the bell curve when you were in high school. And then you went to college where you continued to be at the top of the bell curve. Now that you’re in medical school, we’ve got to remake the bell curve. I can assure you that half of you will be on the bottom side. So study hard and do your best. That is all you can ever give.

Your medical school experience, particularly in the third and fourth years, will be shaped entirely by the people you are around. For some of you, you will hit the jackpot and have a team where the interns are on top of everything, the residents love to teach, and your classmates are eager participants. Others of you will be stuck with ignorant interns, student-hating residents, and classmates that you will constantly cover for. Those four weeks will be your private hell.

That is all I can tell you at this point. But trust me on the studying.